Treatment Services: Triangulation of Methods When There Is No Gold Standard

Brandeis University, Institute for Behavioral Health, Heller School for Social Policy and Management, Waltham, Massachusetts 02454, USA.
Substance Use &amp Misuse (Impact Factor: 1.23). 11/2010; 46(5):620-32. DOI: 10.3109/10826084.2010.528119
Source: PubMed


Information about treatment services can be ascertained in several ways. We examine the level of agreement among data on substance user treatment services collected via multiple methods and respondents in the nationally representative Alcohol and Drug Services Study (ADSS, 1996-1999), and potential reasons for discrepancies. Data were obtained separately from facility director reports, treatment record abstracts, and client interviews. Concordance was generally acceptable across methods and respondents. Although any of these methods should be adequate, additional information is gleaned from multiple sources.

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    ABSTRACT: Background This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation.Methods The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted.ResultsThe sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%.Conclusion The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.
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